Description

Infection of the trachea associated with airway inflammation and obstruction

• Acute tracheitis: sudden onset; higher morbidity and mortality
• Subacute tracheitis: indolent presentation and course; more common among children with prolonged intubation, tracheostomy, and/or underlying respiratory or neurologic conditions

Epidemiology

• Viral prodrome common
• Increased incidence during viral respiratory season (fall and winter): up to 75% coinfected with influenza A
• Gender predisposition unclear (1.3:1 male-to-female ratio has been reported.)
• 2–3% mortality rate

Risk Factors

• Antecedent viral infection, especially croup
• Tracheal trauma

General Prevention

• Routine childhood immunization with Haemophilus influenzae type b, influenza, measles, and pneumococcal vaccines
• Avoid overaggressive suctioning of children with artificial airways.

Pathophysiology

• Epithelial damage from a viral infection or mechanical trauma (e.g., endotracheal intubation, surgical procedure) occurs in the trachea at the level of the cricoid cartilage. As a result, the damaged tissue is more susceptible to bacterial superinfection.
• Mucosal damage characterized by marked subglottic edema, copious purulent secretions, and a pseudomembrane (mucosal lining, inflammatory products, and bacteria). These changes lead to marked airway obstruction.
• Toxic shock syndrome may be a consequence if the infection is associated with toxin-producing strains of Staphylococcus aureus or Streptococcus pyogenes.

Etiology

• Bacteria
  • S. aureus (most common), group A β-hemolytic Streptococcus, Moraxella catarrhalis, nontypeable H. influenzae, Streptococcus pneumoniae
  • Pseudomonas aeruginosa and other gram-negative enteric bacteria have been associated with health care–associated infections.
  • Mycobacterium tuberculosis, Mycoplasma pneumoniae, Corynebacterium diphtheriae, H. influenzae type b, and respiratory anaerobic bacteria are uncommon pathogens.
• Viruses: Influenza, parainfluenza, respiratory syncytial, herpes simplex, and measles viruses have been found with bacterial pathogen(s).
• Fungi: seen with underlying immunodeficiency disorders or chronic steroid use